Pelvic Inflammatory Disease
Pelvic inflammatory disease, also known as PID, is just what its name suggests—an inflammation of one or more of a woman’s pelvic reproductive organs, including the uterus, ovaries, and fallopian tubes. It is caused by bacterial infection, most often resulting from a sexually transmitted disease (STD). Pelvic inflammatory disease is a serious condition that affects over a million American women each year, 100,000 of whom become infertile as a result.
In some cases, pelvic inflammatory disease presents with no symptoms at all. However, most women who experience this condition suffer from a range of unpleasant symptoms, including:
- Fever (often above 100°F) and chills
- Abdominal pain or tenderness (usually felt in the lower abdomen) or severe pelvic area pain
- Foul-smelling yellow or green vaginal discharge
- Bleeding or menstrual irregularities
- Nausea and vomiting
- Painful intercourse
- Painful urination
While these symptoms are common in cases of PID, they are not universal, and many women with inflammatory pelvic infections experience no symptoms.
Causes of Pelvic Inflammatory Disease
The most common causes of pelvic inflammatory disease are gonorrhea and chlamydia, two types of infections that are spread via sexual contact. The bacteria that cause these infections are carried in the man’s semen and find their way through the vagina to the woman’s cervix. During this process, it is also possible for the urethra and anus to become infected.
It is less common, but not unheard of, for PID infection to result from childbirth, miscarriage, or surgery such as abortion. PID is much more common in regions of the world where abortion is illegal and therefore more likely to be performed in unsanitary conditions. PID can also develop as a complication of office gynecological procedures such as insertion of an IUD or an endometrial biopsy, for example.
The same statistical risk factors that affect the spread of sexually transmitted diseases apply to pelvic inflammatory disease. PID most commonly strikes sexually active women under the age of 25, especially if they have multiple sex partners. Carelessness about safe sex (i.e., condom use) is another important risk factor for PID.
Douching is another unnecessary risk. According to the National Institutes of Health, the American Academy of Family Physicians, and other authorities, douching can actually push harmful bacteria up into your genital tract. Moreover, douching can kill benign bacteria that live naturally in your body and normally act to protect you from infections and diseases like PID. Douching as a form of routine feminine hygiene used to be common, but it is no longer advised.
Because it can affect several of the reproductive organs, pelvic inflammatory disease has the potential to cause permanent infertility if not promptly and properly treated. PID can also cause scarring of these organs (sometimes similar to the scarring inside the uterus characteristic of Asherman’s syndrome), which can lead to ectopic pregnancy, an extremely dangerous condition in which a fertilized egg implants outside the uterus.
If the infection is left untreated for long enough, it can spread beyond the reproductive organs, or possibly into the bloodstream, and affect more vital systems in the body, causing even more dangerous, possibly life-threatening complications.
Diagnosis and Treatment of PID
If your doctor suspects that you have pelvic inflammatory disease, he or she will give you a thorough physical examination. You will also be asked some rather personal questions about your sexual habits. Try to take this in stride; the doctor is not trying to shame you, but he or she needs to know how likely you are to have acquired a sexually transmitted infection. If you have a regular sex partner, he or she should also be tested for gonorrhea and chlamydia.
After conducting a thorough physical (most likely including a pelvic exam), the doctor will take cervical fluid samples and possibly blood samples as well. Other tests that may be performed include ultrasound and possibly endometrial biopsy, which involves taking a tissue sample from the endometrium (the uterine lining).
Pelvic inflammatory disease can usually be treated with antibiotics, although hospitalization is sometimes required if the patient is pregnant, or if the disease is very advanced and has begun to cause serious complications. In some cases, abscesses may form in ovaries or fallopian tubes, and this too is cause for hospitalization. If you are being treated for PID with antibiotics, it is very important that you continue to take them for the entire course prescribed by your doctor. Once your symptoms disappear, you may be tempted to stop taking the antibiotics, but by doing so you risk the return of the infection.
The simplest and most effective way to prevent pelvic inflammatory disease is to wear a condom every time you have sex. Avoid having sex with people you do not know, or whose medical and sexual history are cause for concern.
If it is diagnosed and treated early, the prognosis for pelvic inflammatory disease is excellent. Bacterial infections can easily be cured with antibiotics before they are able to do lasting harm to your reproductive system. Once this damage has been done, however, it can be hard to undo. The inflammation caused by PID can cause scar tissue to form in the fallopian tubes, which can block them. If this occurs, surgery may be necessary to restore fertility, and sometimes in-vitro fertilization is needed in order to become pregnant.